Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5W9, Canada.
Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Road East, E3-206, London, ON, N6A 5W9, Canada.
Pediatr Nephrol. 2024 Apr;39(4):1169-1176. doi: 10.1007/s00467-023-06185-5. Epub 2023 Oct 16.
When applying Pierce U25 formula for estimating glomerular filtration rate (eGFR), we observed a higher proportion of eGFR < 90 mL/min/1.73 m (chronic kidney disease (CKD) stage 2). We compared agreement and accuracy of the Pierce U25 (ages 2-25), Pottel (ages 2-100), and CKD-EPI (ages 18-100) formulae to GFR measurements.
Post hoc analysis of the three eGFRs compared to 367 m technetium-diethylene-triamine penta-acetic acid (Tc DTPA) GFR measurements (240 patients) using 3 sampling points and Brockner/Mørtensen correction (body surface area calculation based on ideal weight) on simultaneous serum creatinine and cystatin C measurements.
Overall, the U25 formula performed well with a Spearman r of 0.8102 (95% confidence interval 0.7706 to 0.8435, p < 0.0001) while diagnostic accuracy was low in patients with normal mGFR. The U25 formula reclassified 29.5% of patients with normal mGFR as CKD stage 2; whereas the average of the modified Schwartz formula based on serum creatinine and the Filler formula based on cystatin C, only over-diagnosed CKD stage 2 in 8.5%, 24.5% within 10% and 62.7% within 30%. We therefore combined both. The average Schwartz/Filler eGFR had 36.5% of results within 10%, 84.7% within 30%, and normal mGFR accuracy was 26.8%, 63.9% for 10% and 30%, respectively, outperforming the CKD-EPI and Pottel formulae.
The Pierce U25 formula results correlated well with mGFR < 75 mL/min/1.73 m. Over the entire GFR range, accuracy was better for patients with a higher mGFR, when averaging the combined Schwartz/Filler formulae. More work is needed to prospectively confirm our findings in other centers.
当应用 Pierce U25 公式估算肾小球滤过率（eGFR）时，我们观察到 eGFR<90mL/min/1.73m（慢性肾脏病（CKD）2 期）的比例较高。我们比较了 Pierce U25（年龄 2-25 岁）、Pottel（年龄 2-100 岁）和 CKD-EPI（年龄 18-100 岁）公式与 GFR 测量值的一致性和准确性。
对 367 例患者的 3 种 eGFR 与 367 例锝-二乙三胺五乙酸（Tc DTPA）GFR 测量值（240 例患者）进行了事后分析，使用 3 个采样点和 Brockner/Mørtensen 校正（基于理想体重的体表面积计算）进行同时血清肌酐和胱抑素 C 测量。
总体而言，U25 公式的 Spearman r 为 0.8102（95%置信区间为 0.7706-0.8435，p<0.0001），而在正常 mGFR 患者中诊断准确性较低。U25 公式重新分类了 29.5%的正常 mGFR 患者为 CKD 2 期；而基于血清肌酐的改良 Schwartz 公式和基于胱抑素 C 的 Filler 公式的平均值，仅在 8.5%、24.5%和 62.7%的范围内过度诊断 CKD 2 期。因此，我们将两者结合起来。平均 Schwartz/Filler eGFR 的结果有 36.5%在 10%以内，84.7%在 30%以内，正常 mGFR 的准确性分别为 26.8%、63.9%和 30%。表现优于 CKD-EPI 和 Pottel 公式。
Pierce U25 公式的结果与 mGFR<75mL/min/1.73m 相关良好。在整个 GFR 范围内，当平均 Schwartz/Filler 公式时，mGFR 较高的患者的准确性更好。需要进一步的工作来前瞻性地在其他中心证实我们的发现。
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